Can You Rebuild Bone Density? What the Trials Found

Yes, modestly. Bone density can be rebuilt by a few per cent with the right kind of exercise and held steady with enough calcium, protein and vitamin D; it cannot be returned to what it was at 30 by diet or supplements alone. In the best-known trial, eight months of supervised heavy resistance and impact training raised spine density 2.9% in post-menopausal women with low bone mass; gentle home exercise lost 1.2%.¹ The UK figures are 700 mg of calcium a day, mostly from food, and 10 micrograms of vitamin D in autumn and winter.^{3, 6} Where a scan shows osteoporosis, medicines add more density than any of this: a GP conversation.

• Raises density: progressive resistance training and impact, twice a week, over months
• Holds it: 700 mg of calcium, enough protein, vitamin D sufficiency, oestrogen
• Loses it: the menopause years, smoking, heavy drinking, very low body weight, inactivity

What is bone density, and how does it change with age?

Bone density is the amount of mineral in a given area of bone, measured by a DEXA scan and reported as a T-score. Bone is living tissue, constantly removed and rebuilt: until about 30 building wins, then the two balance, and from the late forties removal slowly takes over. The menopause is the steep part, because oestrogen holds the bone-removing cells in check; women lose bone fastest in the first few years after their periods stop, men later and more slowly.¹² Joint pain is a different subject: see the Wellgard joint health guide.

Can you rebuild bone density?

Yes, by a few per cent, and the lever is load. In the LIFTMOR trial, 101 post-menopausal women with osteopenia or osteoporosis trained for 30 supervised minutes twice a week for eight months: deadlifts, squats and overhead presses at over 85% of their maximum, plus jumping chin-ups with a drop landing. Spine density rose 2.9% against a 1.2% loss in the home-exercise group, with one minor adverse event.¹ The Cochrane review of 43 trials found progressive leg resistance training added about 1% at the femoral neck and combined programmes about 3% at the spine.² One caution: a T-score of -2.8 that improves 3% is still in the osteoporosis range.

Which exercises increase bone density?

Bone responds to loads that are heavy, fast or unfamiliar, which is why cycling, swimming and ordinary walking do little for density and heavy lifting and jumping do most. Five to build around: squats, deadlifts, overhead presses, step-ups and jumps or heel drops, the first four loaded progressively, the last daily.

With a diagnosis, start under supervision; the NHS advises weight-bearing plus muscle-strengthening exercise on two or more days a week.¹²

How can I improve my bone health?

Exercise raises the number; nutrition lets the gain stand.

Calcium

UK adults need 700 mg a day, mostly from food; foods high in calcium lists UK portions.³ Calcium from food or a supplement raises bone density by the same 1 to 2% in the first year, then plateaus; supplements reduced fractures by about 11% across 26 trials but not in the best-run ones, so the aim is to meet 700 mg, not exceed it; do you need a calcium supplement works out who has a gap.^{4, 5} Whether tablets affect the heart is unresolved; the NHS puts 1,500 mg a day as unlikely to cause harm.³ Calcium is needed for the maintenance of normal bones and teeth, and vitamin D contributes to the maintenance of normal bones and to the normal absorption and utilisation of calcium.

Vitamin D

The NHS advises 10 micrograms a day in autumn and winter and no more than 100 micrograms.⁶ Vitamin D does not add density to a skeleton that already has enough: 2,000 IU a day for five years in 25,871 adults not selected for low vitamin D made no difference to fractures, and an 81-trial analysis found no effect on fractures, falls or density.^{7, 8} It helps where deficiency is common: with calcium, it cut hip fractures by about 16% in the Cochrane review, nine fewer per 1,000 care-home residents a year.⁹ Within that limit, vitamin D contributes to the maintenance of normal bones and to normal muscle function; vitamin D3 and K2 has the detail.

Protein

Higher protein intakes are good for bone: the 2017 National Osteoporosis Foundation review found slightly higher spine density with more protein, no harm, and no support for the idea that protein acidifies the blood and leaches calcium.¹⁰ Aim for at least 1 g per kilogram of body weight a day in later life; protein contributes to the maintenance of normal bones.

Vitamin K2 and magnesium

Vitamin K contributes to the maintenance of normal bones (what foods are high in vitamin K2 lists the sources); the trials are mixed: one three-year trial of 180 micrograms of MK-7 a day slowed spine and femoral neck loss, one-year trials at higher doses changed nothing, and the 2019 review found no evidence vitamin K changes bone density or spinal fractures.¹¹ Magnesium contributes to the maintenance of normal bones; its supplement trials on bone are few and small. Dietary silicon is an observation: in 2,847 Framingham Offspring adults, higher intake went with up to 10% higher hip density in men and premenopausal women but not postmenopausal women; the one 12-month trial raised a bone-collagen marker, not spine density. Silicon has no authorised bone claim; what is silica good for has the studies and foods high in silica the sources.^{15, 16}

Collagen peptides

One adequately sized trial: 131 post-menopausal women took 5 g of collagen peptides or placebo daily for a year, and spine and hip density rose on collagen while placebo fell.¹³ One manufacturer-funded trial, reported as evidence; collagen has no authorised claim. Collagen peptides are about nine-tenths protein, which contributes to the maintenance of normal bones; what type of collagen is best for bones has the detail, collagen trials by age the recruitment ages.

What are 3 important things for bone health?

Load, nutrition and hormones. Load is resistance and impact exercise twice a week, progressed over months, shown in trials to raise density.^{1, 2} Nutrition is 700 mg of calcium, enough protein and vitamin D sufficiency. Hormones: oestrogen protects bone until the menopause, and HRT is a medicine question for your GP; which menopause supplements have evidence covers the non-prescription side.

What are 3 things you can do to strengthen your bones?

This week: two strength sessions for the legs, hips and back with a weight you can lift about eight times, plus some daily hops or jumps if your joints allow. This month: count your calcium against 700 mg and close the gap, and start 10 micrograms of vitamin D between October and March. This year: if you are over 50 with a risk factor, ask your GP for a fracture-risk assessment.

What should you avoid?

Smoking, more than 14 units of alcohol a week, a very low body weight, bed rest and long inactivity all cost bone, and vitamin D above the 100 microgram limit adds no more density.^{6, 8}

When is a DEXA scan offered, and what does a T-score mean?

In the UK a DEXA scan is offered when a fracture-risk assessment (FRAX or QFracture) puts you at raised risk: usually over 50 with a risk factor, or under 50 with a strong one such as long-term steroids.¹² The scan compares your density with a healthy young adult's: -1 or above is normal, -1 to -2.5 is osteopenia, below -2.5 is osteoporosis. Osteopenia is a band on a scan, not a disease. Whether to start medicine rests on fracture risk, not the number alone, and is your GP's conversation.

Frequently asked questions

Can you regrow bone density after 60 or 70?

Yes, modestly: the LIFTMOR women averaged 65 and the Cochrane trials ran into the eighties. Gains of 1 to 3% are realistic with supervised progressive loading.^{1, 2}

What is the fastest way to increase bone density?

There is none. Bone remodels over months, so the earliest a scan can show change is about a year; supervised heavy resistance and impact training is the fastest route.

What is the number one vitamin for bone density?

There is no single one. Vitamin D and calcium hold the authorised bone roles and matter most when you are short of them; neither raises density in people who have enough.^{7, 8}

Does vitamin B12 help bone density?

No evidence that it does: in the B-PROOF trial, two years of vitamin B12 with folic acid in older adults did not change bone density.¹⁴

Which foods and drinks are best for bone density?

Dairy, tinned fish with bones, tofu and fortified plant milks for calcium; meat, fish, eggs and pulses for protein.

Sources

1. Watson SL, et al. High-intensity resistance and impact training in postmenopausal women with low bone mass: the LIFTMOR trial. Journal of Bone and Mineral Research, 2018. PubMed 28975661.
2. Howe TE, et al. Exercise for osteoporosis in postmenopausal women (Cochrane review). Cochrane Database of Systematic Reviews, 2011. PubMed 21735380.
3. NHS. Calcium. nhs.uk/conditions/vitamins-and-minerals/calcium.
4. Tai V, et al. Calcium intake and bone mineral density. BMJ, 2015. PubMed 26420598.
5. Bolland MJ, et al. Calcium intake and risk of fracture. BMJ, 2015. PubMed 26420387.
6. NHS. Vitamin D. nhs.uk/conditions/vitamins-and-minerals/vitamin-d.
7. LeBoff MS, et al. Supplemental vitamin D and incident fractures in midlife and older adults. New England Journal of Medicine, 2022. PubMed 35939577.
8. Bolland MJ, et al. Effects of vitamin D supplementation on musculoskeletal health. Lancet Diabetes & Endocrinology, 2018. PubMed 30293909.
9. Avenell A, et al. Vitamin D and vitamin D analogues for preventing fractures (Cochrane review). Cochrane Database of Systematic Reviews, 2014. PubMed 24729336.
10. Shams-White MM, et al. Dietary protein and bone health (National Osteoporosis Foundation review). American Journal of Clinical Nutrition, 2017. PubMed 28404575.
11. Mott A, et al. Effect of vitamin K on bone mineral density and fractures in adults. Osteoporosis International, 2019. PubMed 31076817.
12. NHS. Osteoporosis. nhs.uk/conditions/osteoporosis.
13. König D, et al. Specific collagen peptides improve bone mineral density and bone markers in postmenopausal women. Nutrients, 2018. PubMed 29337906.
14. Enneman AW, et al. Vitamin B12 and folic acid supplementation and bone mineral density in older people: B-PROOF. Calcified Tissue International, 2015. PubMed 25712255.
15. Jugdaohsingh R, et al. Dietary silicon intake and bone mineral density. Journal of Bone and Mineral Research, 2004. PubMed 14969400.
16. Spector TD, et al. Choline-stabilized orthosilicic acid as an adjunct to calcium/vitamin D3 in osteopenic females: a randomized, placebo-controlled trial. BMC Musculoskeletal Disorders, 2008. PubMed 18547426.

This article is general information, not medical advice. A fracture from a minor fall, or joint pain with swelling, heat or after an injury, needs a GP.